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Erectile Dysfunction (Impotence)

Erectile Dysfunction is sometimes known as ED or impotence. It refers to a condition in which a man is unable to achieve or sustain an erection. Erectile Dysfunction affects as many as fifteen million men in the United States in any given year.

This article takes an in-depth look at the causes of and treatments for erectile dysfunction.

Erectile Dysfunction: Myths And Facts

For years, erectile dysfunction was regarded as a shameful condition. "Impotent" was one of the worst insults one could fling at a man. Legend has it that one of the reasons Anne Boleyn was beheaded had to do with her taunting her husband, Henry VIII, with his "impotence."

There are several unfortunate myths surrounding erectile dysfunction-here are a few of the most common.

Myth: Erectile dysfunction is all in my head.Fact: Most cases of erectile dysfunction have at least some physiological basis.

Myth: If my partner has erectile dysfunction, it means he's not attracted to me.Fact: Achieving an obtaining an erection is actually a fairly complicated biological process. Even if he thinks you're a knockout, your partner may be experiencing physical problems that prevent him from becoming erect.

Myth: Sildenafil citrate is a surefire cure for erectile dysfunction.Fact: Sildenafil citrate and its sister drugs do help a large percentage of men with erectile dysfunction-anywhere between sixty and seventy percent. But some men can't take Sildenafil citrate (for instance, men with a heart condition that requires the use of nitroglycerin) and others aren't helped by it. Don't be discouraged if you need to look into several treatment options to resolve your erectile dysfunction.

Myth: All men develop erectile dysfunction as they age.Fact: As they age, men require more stimulation to achieve an erection, but this does not mean they suffer from erectile dysfunction. Erectile dysfunction refers to the inability to achieve and maintain an erection in spite of appropriate stimulation. It is true that older men have more risk factors for erectile dysfunction, but that certainly doesn't mean that all-or even most-of them will actually experience the condition.

Myth: Erectile dysfunction is exclusively an old man's problem.Fact: Men of all ages develop erectile dysfunction. In younger men, the cause tends to be psychological; in older men, the cause tends to be physical.

Myth: Counseling has no place in erectile dysfunction treatmentFact: Whatever the cause of your erectile dysfunction, counseling can play a huge role in restoring your self confidence, strengthening your relationship with your partner, and teaching you new and fulfilling ways to express your sexuality.

Now that you've learned some of the myths and facts, it's time to take an in depth look at erectile dysfunction. Before you understand erectile dysfunction, however, it's important to understand how a man achieves and maintains an erection.

Achieving And Maintaining An Erection

Although most men are probably not aware of this, achieving and maintaining an erection is no simple prospect. If even one of a series of complicated steps goes wrong, erectile dysfunction is the likely result.

To understand how a man achieves an erection, it is first important to understand the anatomy of the penis. The penis is made up of three distinct cylinders. The corpus cavernosum are a matched pair of cylinders that lie along the sides of the penis. The corpus spongiosum, which contains the urethra (the tube through which urine passes) nestles in a groove between the two corpus caverrnosum. The corpus spongiosum also makes up the super-sensitive tip of the penis, known as the glans.

The three cylinders are comprised of spongy tissue and covered with a tough membrane to protect the delicate tissues beneath. When blood fills the spongy tissues of the cylinders, an erection occurs. The erection usually lasts long enough to complete orgasm. Some men, however, have a condition called venous leak, which causes the blood to flow out of the penis too soon. These men can usually achieve an erection, but they cannot maintain one.

In order for blood to start filling the spongy cylinders and produce an erection, several things need to happen.

Most erections are triggered by arousal, such as looking at an erotic picture or a potential partner. Sometimes, however, especially among younger men, fear and embarrassment may also trigger unwanted erections.

When the brain is aroused, it sends a message to the nervous system to release chemicals into the bloodstream that enlarge the blood vessels in the penis, a little like stretching a balloon so you can blow more air into it. Blood then flows into the spongy tissue, creating an erection.

Erectile dysfunction can be caused by a failure of any of these functions. If, for instance, the man is not aroused, if he has a spinal injury that prevents the involvement of the nervous system, if he has a damaged nerve or enlarged tissue that cuts off the penile blood supply, erectile dysfunction is the likely result.

Common Causes of Erectile Dysfunction

Many years ago, erectile dysfunction was treated as a psychological problem. A man with erectile dysfunction was likely to find himself accused of being secretly gay or of exhausting himself with masturbation. Certainly, there are psychological issues that contribute to erectile dysfunction-performance anxiety, relationship problems, and fatigue are just a few of the issues that can result in erectile dysfunction.

However, researchers estimate that only about 10% of erectile dysfunction cases are caused exclusively by psychological issues. Erectile dysfunction in younger men is more likely to be caused by psychological issues than is erectile dysfunction in older men.

There are many physical causes of erectile dysfunction. Serious neurological injuries like spinal cord damage or brain damage may interfere with the biological functions that must happen for an erection to be achieved.

A more subtle cause of erectile dysfunction is nerve damage. The pelvis is an area rich in nerves, and if even minor damage occurs to any of these nerves, erectile dysfunction may result. Causes of nerve damage include diabetes, pelvic or rectal surgeries, sports injuries, prostate enlargement and/or prostate surgery, etc.

Still another common cause of erectile dysfunction is a hardening of the arteries that carry blood to the penis. Atherosclerosis, the technical term for hardening of the arteries, can be caused by poor nutrition (e.g., too many foods high in fats), diabetes, or simply encroaching age.

A common cause of erectile dysfunction in younger men is the "venous leak." Venous leak is a condition that causes the blood the blood pumped into the penis to leak back out. Men with venous leak usually have no trouble achieving an erection, but cannot maintain one long enough to enjoy sexual relations. Venous leak is usually caused by trauma to the pelvic area.

Finally, certain kinds of medications may cause erectile dysfunction. Anti-depressants, alpha-blockers (for high blood pressure), allergy meds containing antihistamines, and ulcer medication can all lead to erectile dysfunction. Alcohol, tobacco, and street drugs can also contribute to erectile dysfunction.

Erectile Dysfunction: When To See A Doctor

Every man has an "off" night from time to time. If you experience occasional erectile dysfunction but on the whole find your sex life satisfying, you probably don't need a full urological workup.

Here are a few guidelines to tell when it's time to make that phone call to your doctor:

You always or nearly always experience erectile dysfunction when you try to have sex.

Erectile dysfunction is putting a strain on your primary relationship

Erectile dysfunction is causing you considerable worry or anxiety

You cannot achieve an erection with masturbation

You do not have erections or nocturnal emissions (wet dreams) at night

You have suffered a recent injury to your penis or to your pelvic or anal area

You just have a "gut feeling" that something is wrong

Erectile Dysfunction: Why To See A Doctor

In the United States, there is a myth that men are always "up for" sex. A man experiencing erectile dysfunction may feel embarrassed about seeing a doctor and discussing the finer points of his sex life.

Still, if you are experiencing erectile dysfunction, you should see your doctor for several reasons.

First, erectile dysfunction can do great harm to one's self esteem, not to mention one's sexual relationships with a spouse or a partner. Many men worry needlessly over erectile dysfunction, believing the condition somehow makes them less than real men.

Second, there are currently many options for diagnosing and treating erectile dysfunction that didn't exist even as little as twenty years ago. A visit to the doctor could mean the difference between continued frustration and quick resolution.

Finally, there are times when erectile dysfunction is a symptom of a more serious disorder, such as prostate cancer or a pituitary tumor. Only your doctor can rule out these potentially life threatening conditions.

If you are still too embarrassed to talk to your primary are physician (though you have no reason to be-unless it's his first day of practice, he's heard it all before and won't think any less of you), then make an appointment with a urologist.

Whatever you do, don't delay. There's no reason why erectile dysfunction should continue making you miserable for another minute.

Erectile Dysfunction: Diagnosis

When you see your doctor for erectile dysfunction, he or she will probably run several tests to determine the cause of the problem. First, your doctor will obtain a complete history of the problem. When did it start? Did anything unusual happen right before that (e.g., a fight with your partner or an injury to your groin)? Do you still feel sexual arousal? Are you ever able to achieve and maintain an erection? If so, under what circumstances? Has anything you've done made the problem better or worse?

You'll also get a series of routine blood and urine tests and probably a pelvic ultrasound or color Doppler study to look for any blood flow blockages.

Depending on these results, you may undergo some other tests as well. For instance, your doctor may bring you into a sleep lab to see whether you get erections at night. If you are able to achieve and maintain an erection (and possibly even reach orgasm) in your sleep, your problem is most likely due to stress, anxiety, or some other psychological issue. If not, there is most likely a physiological reason behind your erectile dysfunction

Your doctor may also do a test known as a bulbocavernosus reflex to test sensitivity. In this test, the doctor lightly squeezes the head of your penis. If your nerve sensation is normal, your anus should immediately contract. If it doesn't, your doctor will know that your nerves are not functioning as they should.

If your doctor suspects a blocked artery, he or she may perform an arteriography. In this test, the doctor injects a special kind of dye into an artery and use X-rays to follow the dye as it travels through your system. Any blockages will be highlighted by the dye.

If venous leak is suspected, the doctor will probably perform a cavernosography or a cavernosometry. These tests involve injecting fluids into the penis and measuring how quickly they flow back out.

Erectile Dysfunction Treatment: Counseling

Although only about ten percent of men with erectile dysfunction have no physiological basis for their condition, counseling may still be an important part of dealing with erectile dysfunction for several reasons.

First, erectile dysfunction can put a strain on even the healthiest and most loving of sexual relationships. You and your partner may benefit from couples counseling to rebuild your sexual bond and deal with the medical condition that originally caused your erectile dysfunction. For instance, if you have been newly diagnosed with diabetes or atherosclerosis, you and your partner may need to agree to make some lifestyle changes to control your condition.

Second, erectile dysfunction can be very damaging to a man's self esteem, and knowing that the problem can be traced to a medical condition isn't always as much of a relief as you might expect. For some men, learning that they have a physiological condition that has resulted in erectile dysfunction may feel like the end of their potency and youth. A counselor can help you put things in perspective and change some of the negative thoughts that may be running through your head.

Finally, you will probably be referred to counseling if your doctor can find no medical reason for your erectile dysfunction. Counseling will focus on educating you about normal sexual response, exploring and possibly challenging negative ideas you may have about sexuality, giving you tips about managing stress, and setting specific behavioral goals aimed at helping you reconnect with your sexual partner(s).

Erectile Dysfunction Treatment: Lifestyle Changes

You and your doctor may identify some lifestyle that will help alleviate your erectile dysfunction.

Drinking to excess, smoking, or using street drugs can cause erectile dysfunction. Your doctor will probably advise you to cut back on your use of alcohol and avoid smoking and street drugs entirely. If you find yourself unable to stop using alcohol or drugs, you might want to consider attending a self help group such as Alcoholics Anonymous or seeing a counselor who specializes in alcohol and drug treatment.

If you are overweight, your doctor will probably advise you to try to lose a few pounds. It is certainly a good idea to avoid fatty foods which tend to clog the arteries and lead to reduced blood flow to the penis.

Beginning and maintaining a daily exercise program will also help improve your overall health which will probably lead to some relief of your erectile dysfunction.

Erectile Dysfunction Treatment: Oral Medications

For years, little could be done to treat the physical causes of erectile dysfunction. Then, about ten years ago, Sildenafil citrate burst onto the scene and the whole picture changed.

Sildenafil citrate and other medications in its class (e.g., Tadalafil and Vardenafil) are PDE-5 inhibitors. They work by increasing nitrous oxide in the blood vessels of the penis. This, in term, stimulates increased blood flow. PDE-5 inhibitors should be taken about half an hour to an hour before sex. A feeling of sexual arousal is necessary for the medication to work-in other words, you won't arbitrarily develop an erection thirty minutes after taking the pill unless you feel sexual arousal towards something in your environment. PDE-5 inhibitors work on sixty to seventy percent of men with erectile dysfunction.

PDE-5 inhibitors are usually considered safe, but they absolutely should not be taken by anyone who is using nitroglycerin or alpha-blockers. Common side effects include headache, flushed face, indigestion, and runny nose.

Erectile Dysfunction Treatment: Other Options

Sildenafil citrate and other PDE-5 inhibitors work well for more than half the men who use it. But what if Sildenafil citrate doesn't work for you, or its use is contraindicated by another medical condition? There are some other options to try.

For instance, your doctor may suggest a Medical Urethral System for Erection (MUSE). MUSE is a medication called alprostadil. It comes as a suppository which is inserted directly into the urethra. The drug relaxes the smooth muscles in the penis, allowing the penis to become erect. The most common side effect of MUSE is syncope-passing out. Therefore, your first dose of MUSE should be administered under medical supervision.

Another common treatment for erectile dysfunction is the intra-cavernosal injection. In this treatment, a combination of three medications, collectively knows as Trimix, is injected directly into one of the spongy cylinders that runs along the side of the penis. These shots induce erections in up to 85 percent of the men who use them. There are some drawbacks to intra-cavernosal injections, however. The treatment is invasive and sometimes painful. The treatment also has an unfortunate side effect known as priapism. Priapism refers to a painful, prolonged erection, sometimes lasting more than five hours. For this reason, any man using intra-cavernosal injections should be within easy distance of emergency medical care.

Another very successful treatment for erectile dysfunction is the vacuum device. It consists of a plastic cylinder with a pump and a constriction ring (sometimes known on the streets as a cock ring) that fits snugly at the base of the penis. The suction from the vacuum draws blood into the penis, and the cock ring keeps it from flowing right back out. This treatment is about 95% successful, but users should note that the constriction ring must be taken off after thirty minutes to restore normal blood flow and avoid deadly complications like gangrene.

Constriction rings without the vacuum component may be helpful if the cause of your erectile dysfunction is venous leak, as they will prevent blood from leaking out of your erect penis.

Still another successful though invasive treatment is called a penile prosthesis. A penile prosthesis is an inflatable tube surgically placed in the penis. A small outside pump allows the user to inflate or deflate the tube as desired. This procedure usually requires an overnight stay in the hospital followed by several days of antibiotics at home. Medication may also be given for pain relief. The most common complication of this procedure is wound infection.

Erectile Dysfunction: Natural Treatments

No vitamins or herbal therapies have been scientifically tested against the current "gold standard" treatments like Sildenafil citrate, vacuum devices, etc. However, vitamins and herbs are unlikely to harm you, so there is no reason not to try them unless your physician is against it.

Herbs rumored to help erectile dysfunction include ginseng, gingko balboa, and muira puama, which is also said to help increase libido.

Erectile Dysfunction: In Conclusion

By now, you should understand that if you suffer from erectile dysfunction, it's not your fault. You should also realize that several highly successful treatments are available.

So if you are plagued by erectile dysfunction, pick up the phone and call your doctor now. There is nothing to be gained from waiting and everything to be gained from making that one phone call which will set you on the road to resuming your sexual life.